Moving on from MEDCAC

Last week, Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) disappointed those who were hoping for full national coverage of low-dose CT screening for patient at high risk for lung cancer.

The panel gave a vote of low confidence to the notion that current evidence definitively confirmed the benefits of low-dose screening outweighed the harms for a Medicare population. Some at the meeting pointed out that the strongest study of the effectiveness of low-dose lung cancer screening, the National Lung Screening Trial, had a low percentage of Medicare-aged participants.

Regardless of whether you agree with MEDCAC’s decision regarding screening coverage for Medicare beneficiaries, there is still work to be done to support screening for other populations. Last December, the U.S. Preventive Services Task Force (USPSTF) recommended that people with a 30 pack-year smoking history who currently smoke or quit within the last 15 years receive low-dose CT screening. It was a grade B recommendation, which under the Affordable Care Act means commercial payers must cover the procedure without a co-pay.

To support screening efforts, the American College of Radiology (ACR) has unveiled a pair of initiatives within the past couple weeks. First, ACR announced the availability of its Lung Imaging Reporting and Data System (Lung-RADS). The quality assurance tool was designed to help standardize CT lung cancer screening reporting and recommendations. You can find Lung-RADS resources here.

The other major announcement from the ACR was the launch of its Lung Cancer Screening Center Program. This program allows providers to apply for designation as a lung cancer screening CT center, provided they meet certain requirements for equipment, personnel and imaging protocols.

For example, to be accredited, sites will have to demonstrate their interpreting physicians have read 200 chest CTs in the prior 36 months, that a smoking cessation program is in place and that a structured reporting system is in use. For more on the designation requirements, you can view that attestation form here, and more information on the Lung Cancer Screening Center Program here.

In a prepared statement, Ella Kazerooni, MD, chair of the ACR Committee on Lung Cancer Screening, said the ACR will help facilities ensure the greatest possible benefit from screening for their patients. “Lung cancer screening in patients at high risk of acquiring the disease is the most effective way to identify tumors and reduce lung cancer deaths.”

-Evan Godt
Editor – Health Imaging